What is the immediate treatment for a peritonsillar abscess?

Immediate Treatment of Peritonsillar Abscess

The immediate treatment for peritonsillar abscess requires drainage of the abscess along with empiric antibiotic therapy effective against group A streptococcus and oral anaerobes. 1, 2

Diagnosis Confirmation

• Diagnosis is typically made based on clinical presentation and examination, with symptoms including fever, sore throat, dysphagia, trismus, and a "hot potato" voice 2
• Imaging (CT or ultrasound) may be used to confirm diagnosis in unclear cases 3

Treatment Algorithm

Step 1: Drainage Procedure

• Needle aspiration is the gold standard for both diagnosis and initial treatment of peritonsillar abscess 3
• Incision and drainage is an alternative when needle aspiration is insufficient 3
• Immediate tonsillectomy may be considered in select cases, particularly for patients with recurrent peritonsillar abscesses 1, 4

Step 2: Antibiotic Therapy

• Initiate empiric antibiotic therapy immediately after diagnosis 1
• Choose antibiotics effective against group A streptococcus and oral anaerobes 2
• Recommended options include:
  • Penicillin combined with metronidazole 3
  • Amoxicillin-clavulanic acid (particularly effective in preventing progression from peritonsillar cellulitis to abscess) 5
  • Clindamycin (for penicillin-allergic patients) 3
  • Cephalosporins with anaerobic coverage 3

Step 3: Supportive Care

• Provide adequate hydration 2
• Implement effective pain control measures 2
• Consider corticosteroids to reduce symptoms and speed recovery 2

Inpatient vs. Outpatient Management

• Most patients can be managed in the outpatient setting after successful drainage 2
• Consider inpatient management for:
  • Patients with significant trismus or inability to maintain oral hydration 2
  • Cases with potential airway compromise 2
  • Patients with extension of infection into deep neck tissues 2
  • Immunocompromised individuals 2

Potential Complications to Monitor

• Airway obstruction requiring immediate intervention 2
• Extension of infection to deep neck spaces 2
• Aspiration 2
• Post-procedure bleeding (occurs in approximately 3.6% of cases) 4

Follow-up Considerations

• Patients with recurrent peritonsillar abscess (more than one episode) should be considered for definitive tonsillectomy 1
• For patients treated with unilateral tonsillectomy, monitor for contralateral peritonsillar infection (occurs in approximately 7% of cases) 4

Common Pitfalls to Avoid

• Delaying drainage, which can lead to extension of infection and increased morbidity 2
• Using inadequate antibiotic coverage that doesn't address both aerobic and anaerobic pathogens 2, 3
• Failing to recognize potential airway compromise requiring urgent intervention 2